Randomized, Open and Controlled Clinical Trial for Evaluation of Treatment With Multiple Infusions of Mononuclear Bone Marrow Cells in Patients With Chronic Liver Diseases
Trial Snapshot
- Phase
- Phase 2
- Sponsor
- Hospital Sao Rafael
- Enrollment
- 30
- Locations
- 1
- Primary Endpoint
- Evaluation of Child-Pugh score
Study Overview
Brief Summary
The purpose of this study is to evaluate the safety and efficacy of multiple infusions of mononuclear bone marrow cells in patients with chronic liver diseases.
Detailed Description
This is a safety/efficacy phase II, open, randomized, controlled clinical trial, with two arms. The study population will consist of 30 patients with chronic decompensated liver disease (Child-Pugh B or C). The candidates included in the study will be asked to voluntarily participate and sign the written consent.
The patients will be allocated randomly into 2 groups: in group A, the patients will undergo the intervention; and in group B, the patients will be the controls. Patients of both groups will receive clinical follow-up. They will be maintained on drug therapy commonly used in patients with cirrhosis, which may include: spironolactone, furosemide, lactulose, metronidazole, neomycin, analogs of nucleoside / nucleotide in patients with hepatitis B, and vitamin complexes.
All patients included in Group A will undergo cell therapy according to the technique described as follows: on day 1 (D-1), patients will be hospitalized to undergo the bone marrow puncture through the iliac crest. 150 to 200 ml of bone marrow aspirate will be collected. The procedure will be done under local anesthesia and sedation. The fraction of mononuclear cells will be isolated from the aspirated marrow by the SEPAX (System of cell processing) - Biosafe, Switzerland.
The enriched fraction of collected mononuclear cells will be resuspended in saline. The obtained cell populations will be analyzed by flow cytometry for its characterization, and then diluted in 20 ml saline. The cells will be injected 3 times throughout the study, on days 1 (D-1), 30 (D-30) and 60 (D-60).
Patients will undergo a series of clinical and laboratory evaluations and will also be submitted to the following procedures:
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Triple (Participant, Care Provider, Investigator)
Eligibility Criteria
- Ages
- 18 Years to 70 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Diagnosis of liver cirrhosis of different etiologies, confirmed by clinical examination, laboratory tests, imaging studies and / or biopsy that shows process of evolution to cirrhosis or established cirrhosis (equivalent to Metavir score F3/F4);
- •Non-participation on the waiting list for liver transplantation or, in case of participation, allocation after the fifth position in the list, for subjects with blood group A or O, and after the third position for subjects with other blood groups;
- •Absence of clinical, laboratory and radiological evidence of hepatocellular carcinoma;
- •Absence of pregnancy potential or negative pregnancy test for female patients, or impossibility to use a contraception method during the study;
- •Permission for doing the puncture of iliac crest after evaluation of pre-anesthetic visit.
Exclusion Criteria
- •Impossibility to obtain vascular access for percutaneous procedure;
- •Hepatic encephalopathy detected at the screening tests;
- •Budd-Chiari syndrome;
- •Severe coagulopathy with INR > 2,4 or platelet count < 30.000;
- •Presence of malignancies (excluding non-melanoma skin cancer);
- •Decompensated heart failure;
- •Primary hematologic diseases;
- •Renal failure with creatinin > 2,5mg/dl;
- •Coinfection with HIV;
- •Pregnancy;
- •Dependence of organic medium such as circulatory or ventilatory;
- •Any other comorbidity with an impact on the survival in 2 years;
- •Participation in other clinical trial.
Arms & Interventions
Control group
Bone marrow mononuclear cell therapy
Intervention: Infusion of bone marrow mononuclear cells. (Biological)
Outcomes
Primary Outcomes
Evaluation of Child-Pugh score
Time Frame: 12 months
Functional class improvement of 2 points on Child-Pugh score.
Evaluation of MELD score
Time Frame: 12 months
Functional class improvement of 2 points on MELD score.
Secondary Outcomes
- Degree of muscle strength(12 months)
- Hepatic fibrosis(12 months)
- Evaluation of functional capacity(12 months)
- Evaluation of fibrosis markers levels(12 months)
- Quality of life(12 months)
- Evaluation of prothrombin time(12 months)
- Evaluation of serum levels of cytokines(12 months)
- Evaluation of serum bilirubin levels(12 months)
- Evaluation of serum albumin levels(12 months)
Investigators
Ricardo Ribeiro dos Santos
PhD
Hospital Sao Rafael